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A physician’s perspective: How many doctors does Nova Scotia really need?

At Doctors Nova Scotia, we often hear first-hand stories from Nova Scotians who don’t have a family doctor. And the data backs up the anecdotes: As of Nov. 2, 2017, the Nova Scotia Health Authority’s website lists vacancies for 72 full-time family doctors, 10 part-time family doctors, and 14 family doctor locums.

Statistics Canada indicates that as many as 90,000 Nova Scotians don’t have a family doctor, while a report commissioned by the provincial government in October 2016 says that as many as 20 percent of people in the Halifax area and 14 percent in rural Nova Scotia are without a family doctor.

Nova Scotia’s Physician Resource Plan indicates the province needs to hire more than 1,000 physicians (both family physicians and specialists) over the next 10 years, both to replace retiring and relocating physicians and to fill new positions.

On the other hand, a report released by the Canadian Institute for Health Information indicates Nova Scotia has the highest doctor-to-patient ratio in the country (this includes family physicians and specialists). On the surface, it seems that Nova Scotia has more doctors per person than any other province. But it’s not that simple.

To reconcile conflicting information with actual needs, we must consider several factors that affect Nova Scotia’s doctor-patient ratio, including specialty services, medical training and research.

Specialty services

Nova Scotia’s doctors provide specialized services – things like organ transplants, complex maternal care and some cancer treatments – to people across the Maritime and Atlantic provinces, not just Nova Scotia residents. That means Nova Scotian doctors are also treating people from New Brunswick, Prince Edward Island and Newfoundland.

Medical training and research

Dalhousie Medical School in Halifax trains medical students and residents, and also has family medicine residency training sites in Kentville, Sydney and Yarmouth. Many doctors across the province teach the next generation of family doctors and specialists, which means they must balance their academic duties with patient care.

Nova Scotia also has a robust medical research program. Physician-researchers work to improve understanding of disease and prevention/treatment. It’s important work, but it takes them away from treating patients.

It’s not simple

As you can see, the doctor-to-patient ratio isn’t as simple as having enough doctors for everyone in the province. The ratio changes significantly when you remember that Nova Scotia’s doctors provide care for people from four provinces, not just one, and factor in doctors who are teaching the next generation of physicians or leading important research.

Increased demand

Nova Scotia has an aging, unhealthy population, which creates increased demand for doctors. According to Statistics Canada and the Conference Board of Canada, Nova Scotia has the second-largest population of people aged 65 and older in the country.

Our province has the highest rates of smoking, asthma and chronic obstructive pulmonary disease (COPD) in the country. Nova Scotia also has the second-highest rate of overweight and obese people in the country. Heavy or binge drinking is part of our province’s culture. These factors mean that Nova Scotians are at increased risk of developing associated chronic health conditions such as heart disease, high blood pressure, diabetes and cancer.

Aging patients with complex conditions require more care. Physicians are a vital part of a health-care system that seeks not only to treat disease, but also prevent it.

The bottom line

Doctors in Nova Scotia believe the best source of information about the number of physicians the province needs is the Nova Scotia Physician Resource Plan. This planning document takes into consideration the uniqueness and complexity of Nova Scotia’s health system, as well as the health of its citizens. It’s the best data we have to determine the number of doctors we need in the province.

According to the government’s Physician Resource Plan, Nova Scotia must hire approximately 1,000 doctors over the next 10 years.

Data alone isn’t enough

We also know that we can’t simply rely on data. Doctors and patients also need to be part of the conversation; only they can explain the unique needs of their communities. For example, a doctor could explain referral and geographic patterns that would not be discerned through assessment of the numbers alone.

What can you do?

Every Nova Scotian should be able to access a primary health care team that includes a family physician.

The best thing you can do is be sure that you are part of the plan. If you don’t have a family doctor, call 811 or go online to add your name to the family practice wait-list that the Nova Scotia Health Authority is building.

Dr. Michelle Dow is President of Doctors Nova Scotia and a family doctor in Meteghan Centre, N.S. She works with five other physicians and a nurse practitioner at the Clare Health Centre, a collaborative-care clinic in Meteghan Centre. Dr. Dow was installed as Doctors Nova Scotia’s President during the association’s annual conference in June 2016.